Cystic fibrosis (CF) is a serious, chronic, and progressive, genetic disease of the body’s mucus glands that is frequently fatal. The disease can affect various body systems including respiratory, digestive, reproductive, and integumentary (sweat glands). People living with CF develop lung infections and lose their ability to breathe over time because of the mucus building up their lungs and other organs.
The Social Security Administration (SSA) recognizes the severity of CF and will likely qualify someone as disabled when her condition meets certain guidelines. Below, we highlight the primary criteria for obtaining disability benefits for CF and how the SSA evaluates those claims. For help getting Social Security disability for cystic fibrosis in Pittsburgh, call Berger and Green in Pittsburgh for a free consultation: 412-661-1400.
What are the criteria to qualify as disabled based on CF?
In Section 3.04 of the Listing of Impairments, the SSA provides all the criteria for qualifying as disabled based on CF. The listing stipulates that when you have any of the following seven markers, the SSA will likely determine you as disabled:
- Your FEV1 is below a value, depending on your age, gender, and height. You can view these values in tables in the Blue Book under both adult and childhood listings. For example, a 5’1” 18-year-old female will need a FEV1 of 1.75 or less; a male of the same height and age would need a FEV1 of 2.05 or less.
- You have had “exacerbations or complications requiring three hospitalizations of any length within a 12-month period and at least 30 days apart.”
- You have spontaneous pneumothorax requiring a chest tube.
- You have had respiratory failure that required at least 48 hours of invasive mechanical ventilation or noninvasive ventilation with BiPAP.
- You have had to have vascular embolization to control pulmonary hemorrhaging.
- A doctor must have measured your SpO2 at 85 to 89 percent (depending on the altitude where your doctor tested you) at least twice within a 12-month period and at least 30 days apart.
- You have had two of the following exacerbations or complications within the last year: “pulmonary exacerbation requiring 10 consecutive days of intravenous antibiotic treatment; pulmonary hemorrhage requiring hospitalization; weight loss requiring daily supplemental nutrition via a gastrostomy or a central venous catheter for at least 90 consecutive days; or CFRD requiring daily insulin therapy for at least 90 consecutive days”.
Our team will work with medical experts and examine your records to determine which criteria you meet to qualify for benefits.
What if my or my child’s CF doesn’t quite fit the criteria?
If your condition falls short of the aforementioned criteria, the SSA will still evaluate your case to see if your CF is disabling. It will perform a residual functional capacity (RFC) assessment to see if you are currently capable of working.
If your doctor has placed restrictions on your activities, such as not lifting heavy objects, or has stated that you must take frequent breaks, avoid dust, or have daily nebulization, for example, then the SSA may still determine you as technically disabled.
The criteria for a disability determination are somewhat different for children. You will want to speak with a local disability attorney that handles CF cases for help pre-determining eligibility and filing for benefits.
What are the other requirements to collect disability benefits?
The criteria for disability benefits for CF are straightforward:
- You must either meet the listing requirements under CF, or your CF (or other related conditions or symptoms) prevent you from working.
- A doctor must expect your condition to last a year or more or result in death.
- You must not be able to make more than $1,130/month because of your impairment.
Those with little work history may need to apply for Supplemental Security Income (SSI), a disability benefit for people with limited income and resources. Those with a thorough work history may qualify for Social Security Disability Insurance (SSDI) benefits if they have enough work credits on their record.
How will the SSA evaluate my disability claim based on CF?
The SSA will want to see all your medical records, which should include your diagnosis and info about the extent of your condition. It will look for documentation such as a positive newborn screen for CF, a history of CF in a sibling, or proof of at least one specific CF phenotype, as well as definitive laboratory tests such as elevated sweat chloride concentrations, two CF gene mutations affecting the CFTR, or abnormalities in ion transport.
The claims examiner will also review non-medical evidence you send them, such as input from your employer, school, or family members about how your condition is affecting your ability to function normally at school or work.
The SSA provides: “If your CF, including pulmonary exacerbations and nonpulmonary complications, does not meet or medically equal a respiratory disorders listing, we may evaluate your CF-related impairments under the listings in the affected body system.”
Do I need an attorney to file a disability claim for CF?
While an attorney is not mandatory, having a legal representative assist you with the disability application process can improve your chances of receiving benefits. A lawyer can answer any questions you may have, assist with the paperwork, help gather evidence, and relieve the burden of any hiccups that may come up during the process. And if for some reason the SSA denies your claim, a lawyer can help you appeal the case and fight for the benefits that you are entitled to.
Also, because our disability lawyers at Berger and Green offer free consultations and because we do not collect legal fees unless you get a benefit award, there is zero risk in having us help you.
Call our office in Pittsburgh today at 412-661-1400 and schedule a meeting to speak to a disability attorney about your disability claim.